Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations

Philip A Linden, Raphael Bueno, Steven J Mentzer, Lambros Zellos, Abraham Lebenthal, Yolonda L Colson, David J Sugarbaker, Michael T Jaklitsch
Annals of Thoracic Surgery 2007, 83 (3): 1129-33

BACKGROUND: Esophageal perforation carries a high mortality and morbidity rate, especially if treatment is delayed more than 24 hours. We present a large series of patients requiring operative treatment of esophageal perforations with attention to an infrequently used method of dealing with delayed intrathoracic perforations.

METHODS: All patients undergoing operative treatment for intrathoracic esophageal perforation at the Brigham and Women's hospital between 1989 and 2003 were reviewed. Mortality, morbidity, length of stay, nature of esophageal injury, type of repair, and outcome were reviewed.

RESULTS: Forty-three operations for perforation of the thoracic esophagus were performed. Overall 30-day or in-hospital mortality was 7.0%, and overall morbidity was 47%. Most acute thoracic esophageal perforations were treated with primary repair and had a mortality rate of 5%, whereas most delayed perforations were treated with T-tube repair and had a mortality rate of 8.7%. The complication rate in the group repaired within 24 hours was 20%, whereas it was 61% in the group repaired after 24 hours. The complication rate in the group repaired within 72 hours was 42%, and it was 82% in the group repaired after 72 hours.

CONCLUSIONS: Treatment of delayed (more than 24 hours) thoracic esophageal perforations with a controlled fistula through T-tube results in a very low mortality similar to that seen with acute perforations (less than 24 hours). Morbidity and length of stay remain high. Delay in treatment of intrathoracic esophageal perforations beyond 24 and 72 hours results in a doubling of morbidity at each interval.

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